X-ray microtomography-based measurements of meniscal allografts

Differences between sexes in the standard and advanced dimensioning of lateral meniscal allografts

BACKGROUND

There are many different methods of meniscal allograft measurements, which depend on individual tissue bank procedures. Due to the lack of a standardised method of dimensioning, measurement results may vary between individual cases. Consequently, allograft may be mismatched to the patient's knee anatomy. The purpose of this study was to measure four meniscal dimensions - two standard and two specific - and then compare them between sexes.

METHODS

Fourteen cadaveric lateral menisci (seven male and seven female) were scanned using a microtomography scanner. The obtained three-dimensional (3-D) models of each meniscus were analysed, taking into account four dimensions: circumference, width, central meniscal concavity, and total meniscal volume. The computer researcher was not informed of the original data of the meniscal samples until the calculations were completed.

RESULTS

No statistical between-sex differences were found in the standard dimensions. The specific dimensions, in turn, presented statistically significant between-sex differences (P>0.05). The mean difference between male and female total volume of the meniscus was equal to 36.59%, and the mean difference between male and female central meniscal concavity surface was equal to 31.22%.

CONCLUSION

This study found that sex should be taken into account as an important factor during a matching procedure performed by tissue bank staff.

Meniscal transplantation: procedures, outcomes, and rehabilitation

Meniscal allograft transplantation (MAT) is a possible treatment option for patients with joint pain after meniscectomy. It is necessary that the joint be aligned and stable. Current evidence shows that MAT improves pain and mechanical function in the mid to long term with patients reporting significantly improved outcomes at up to 15 years following surgery. Studies on survivorship showed up to 76% graft survival at 10 years. Recent studies have suggested a chondroprotective effect, but there is, at present, no evidence to support MAT in the prevention of osteoarthritis. This review article reported the current evidence for MAT showing support for fresh frozen, nonirradiated allografts. However, further research is required to determine the ideal indications for MAT, the optimal graft fixation method, and the safest rehabilitation protocol.

Meniscus tear surgery and meniscus replacement

OBJECTIVE

the menisci are easily injured and difficult to repair. The aim of this study was to analyze the current state of meniscal surgery aimed at preserving morphology and conserving the biomechanics of the knee to prevent joint degeneration.

METHODOLOGY

a search of the electronic medical literature database Medline was conducted, from http://www.ncbi.nlm.nih.gov/pubmed. The search was not limited by language. Candidate articles were identified by searching for those that included the keywords meniscus, surgery, suture, implant, allograft. The limits were included for clinical research and clinical trials. Basic research was not included. The studies selected were evaluated and classified in three different categories: basic science, reconstruction (suture and meniscectomy) and implants (scaffolds and allograft).

RESULTS

the consequences of meniscectomy performed at a young age can lead to a joint cartilage degeneration twenty years later. There are few surgical options for the repair of meniscal injuries in order both to preserve the meniscus and to ensure the long term survival of the knee joint, meniscectomy, repair, suturing the tear, or reconstruction, when a meniscal allograft or synthetic substitute is used to replace the meniscus, but the biomechanical properties of the native meniscus are not reproduced entirely by the scaffolds that exist today.

CONCLUSION

therapies that successfully repair or replace the meniscus are therefore likely to prevent or delay osteoarthritis progression.